CA MAMMAE

Anatomi

Saluran utama:
Axillary pathway
Interpectoral
pathway
Internal mammary
pathway
Pleksus limfatis
dinding perut

Neoplasma

Definisi
Neoplasia: new growth; proliferasi sel yang telah
bertransformasi secara tidak terkontrol
Transformasi: sel normal memiliki karakteristik maligna

Etiologi
Genetik: BRCA1, BRCA2
Hormone: estrogen

Patofisiologi

 Ca Duktus
Infiltrating : papillary, comedo, adeno Ca dengan fibrosis
(scirrhous), medulary Ca dengan infiltrasi limfoid
Non infiltrating : Ca in situ - papilary, comedo

Ca lobulus
Infiltrating
Non infiltrating

Paget Disease
50-60 tahun solitary firm mass
Erupsi kronis, eksem, dari papilla mammae ulcer,
luka basah
Gambaran pagetoid : sel bervakuola, besar, pucat di
epitelium

Pemeriksaan Fisik
Breast enlargement or asymmetry
Nipple changes, retraction, discharge
Ulceration / erythema of the skin of the breast
Axillary mass
Muskuloskeletal discomfort

Metastasis
Soft tissue : kelenjar
Tulang : pelvis, femur, vertebra
Viscera : paru, hati, otak

Management
Surgical and non surgical.
Tergantung dari stage
Stage I dan II prefer operasi
Stage III dan IV terapi sistemik

Surgical
Breast conserving
Mastectomy
Early stage ca mammae eksisi tumor dan regional lymph
node.
Untuk breast-conserving surgery postoperative radiation
treatment risks and long-term sequelae.
Mastectomy untuk pasien yang ada contraindications th/
radiasi

Breast conservation
The relationship between tumor size and breast size.
Large tumors systemic chemotherapy significantly
reduce the size of the tumor
Patients with multicentric tumors mastectomy

 Teknik:
reseksi primary breast cancer ( segmental mastectomy,
lumpectomy, partial mastectomy, wide local excision) 2-mm
cancer-free margin
adjuvant radiation therapy
Breast-conserving therapy (BCT) survival rates equivalent
to those after total mastectomy while preserving the breast
Untuk stage I dan II.

Mastectomy
Indications:
1. tumor large relative to breast size,
2. extensive calcifications on mammography
3. tumors for which clear margins cannot be obtained on wide
local excision,
4. patients with contraindications to breast irradiation.
Contraindications to the use of radiation therapy previous
breast or chest wall irradiation, active lupus or scleroderma, and
pregnancy.

Mastectomy
Jenis mastectomy:
1. A total (simple) mastectomy breast tissue, the nippleareola complex, and skin.
2. An extended simple mastectomy breast tissue, the nippleareola complex, skin, and the level I axillary lymph nodes.
3. A modified radical mastectomy breast tissue, the nippleareola complex, skin, and the level I and level II axillary lymph
nodes.
4. The Halsted radical mastectomy breast tissue and skin,
the nipple-areola complex, the pectoralis major and pectoralis
minor muscles, and the level I, II, and III axillary lymph nodes..

Non SurgicalSebagai adjuvant dan neoadjuvant.

Endocrine
RadiationTherapy
Chemotherapy
Therapy

1.
Neoadjuvant
ALL
STAGES! endocrine elderly women who were
deemed poor candidates for surgery or cytotoxic
radiationuntuk
therapy
is given
Tidak
disarankan
wanita
therapyadjuvant
chemotherapy.

Radiation
to
reduce
the risk
of negative
local
dengan
nodus
limfe
dan
Chemotherapy
recurrence
Neoadjuvant
endocrine therapy
has been shown to
benjolan berukuran
<0.5 cm
Endocrine therapyshrink tumors, enabling breast-conserving surgery in
women
with
hormone receptorpositive
disease who
Current
recommendations
for
untuk benjolan >1 cm
Antibody Therapy Disarankan
otherwise would have to be treated with mastectomy
stages IIIA and IIIB breast cancer
sebagai
adjuvant
setelah
tindakan
2. The most
widely studied
hormone
receptors are
mastectomy
dan kemoterapi.
the
estrogen receptor
and progesterone receptor
tamoxifen , raloxifene.
3. Ablative endokrin oopheroctomy,
adrenalectomy.

Screening
Screening recommendations :
1. for women in a family with a breast and ovarian
cancer syndrome include monthly breast selfexamination beginning at 18 to 20 years of age,
2. semiannual clinical breast examination beginning at
age 25,
3. annual mammography beginning at age 25 or
4.10 years before the earliest age at onset of breast
cancer in a family member.

Prophylactic Mastectomy
Prophylactic mastectomy has been shown to reduce the
chance of developing breast cancer in high-risk women
by 90%

Prognosis
The 5-year survival rate for patients
stage I: 94%;
stage IIA : 85%;
stage IIB : 70%.
stage IIIA : 52%;
stage IIIB : 48%;
stage IV 18%
Breast cancer survival has significantly increased over the past 2
decades due to improvements in screening and local and systemic
therapies.